Michael R. Kelson, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7100 Issued in WA

Practice address

3624 Ensign Rd NE
Suite a
Olympia, WA 98506-5074

Phone

(360) 923-5412

Fax

(360) 923-5382

NPI assigned

Feb 27, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 4, 2013 through Oct 4, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: mkelson596826@direct.multicare.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1356681407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE",
            "address_2": "SUITE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-923-5412",
            "fax_number": "360-923-5382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE",
            "address_2": "SUITE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-923-5412",
            "fax_number": "360-923-5382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELSON",
        "first_name": "MICHAEL",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "7100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louise Kelly, LMHC, CDP, LPC
• Michael C Kelly, NP
• Tonya Michelle Kelly
• Theresa Ford Kelso, MSW
• Lauren Kelson, PA
• Stephen Mathew Kelson, D.D.S., M.D.
• Ken P Lee MD PLLC
• Alta Blanche Kendall, ARNP NNP-BC
• Josefina Kender
• Jeffrey Lee Kendig, LPN

• Oral and Maxillofacial Surgery (Dentist) in Olympia, WA
• Providers in Olympia, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.